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Get Immunization Health History Form - University Of Washington Tacoma - Tacoma Uw

Rter/Year Date of Birth (Mo./Dy./Yr.) Student ID Number UW ID Number PLEASE CHECK EACH ITEM YES OR NO AND FILL IN BLANKS WHEN APPLICABLE 1. Have you ever had BCG (a shot to prevent tuberculosis/TB)? When? 2. Have you ever had a tuberculin (PPD skin test to detect TB? When? 3. Was the TB skin test negative (no swelling)? 4. Have you had a rubella titer (blood test)? Date? Result? 5. Have you had a hepatitis B blood test? Date? Result? 6. Have you ever experienced adverse.

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